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Cardiometabolic Risk Assessment in a Cohort of Children and Adolescents Diagnosed with Hyperinsulinemia 高胰岛素血症儿童和青少年队列的心脏代谢风险评估
Pub Date : 2024-06-04 DOI: 10.3390/diseases12060119
G. Sodero, D. Rigante, L. Pane, L. Sessa, Ludovica Quarta, M. Candelli, C. Cipolla
Background: Individuals with hyperinsulinemia may initially not meet any diagnostic criteria for metabolic syndrome, though displaying a higher risk of cardiovascular complications combined with obesity, diabetes, and hypertension. Aim: The main objective of our study was to assess the diagnostic accuracy of various cardiovascular risk indices in hyperinsulinemic children and adolescents; a secondary objective was to estimate the optimal cut-offs of these indices. Patients and methods: This retrospective single-center study was conducted on 139 patients aged 12.1 ± 2.9 years, managed for hyperinsulinism. Results: We found statistically significant differences in homeostasis model assessment of insulin resistance index (HOMA-IR), triglyceride glucose index (TyG), TyG-body mass index, visceral adiposity index, lipid accumulation product index, fatty liver index, and hepatic steatosis index. At the linear logistic regression assessment, we found that insulin growth factor-1 (IGF-1), HOMA-IR, and ALT/AST ratio were independently associated with confirmed hyperinsulinism. At the multivariate analysis, IGF-1 levels over 203 ng/mL and HOMA-IR higher than 6.2 were respectively associated with a 9- and 18-times higher odds ratio for hyperinsulinism. The other investigated parameters were not significantly related to hyperinsulinism, and could not predict either the presence of hyperinsulinemia or a subsequent cardiovascular risk in our patients. Conclusion: Commonly used indices of cardiovascular risk in adults cannot be considered accurate in confirming hyperinsulinism in children, with the exception of HOMA-IR. Further studies are needed to verify the usefulness of specific cardiovascular risk indices in hyperinsulinemic children and adolescents.
背景:高胰岛素血症患者最初可能不符合代谢综合征的任何诊断标准,但与肥胖、糖尿病和高血压合并出现心血管并发症的风险较高。目的:我们研究的主要目的是评估高胰岛素血症儿童和青少年各种心血管风险指数的诊断准确性;次要目的是估算这些指数的最佳临界值。患者和方法:这项回顾性单中心研究的对象是 139 名因高胰岛素血症接受治疗的患者,年龄为(12.1 ± 2.9)岁。研究结果我们发现,胰岛素抵抗平衡模型评估指数(HOMA-IR)、甘油三酯血糖指数(TyG)、TyG-体重指数、内脏脂肪指数、脂质堆积产物指数、脂肪肝指数和肝脏脂肪变性指数在统计学上存在显著差异。在线性逻辑回归评估中,我们发现胰岛素生长因子-1(IGF-1)、HOMA-IR 和 ALT/AST 比值与确诊的高胰岛素血症独立相关。在多变量分析中,IGF-1 水平超过 203 纳克/毫升和 HOMA-IR 高于 6.2 分别与高胰岛素血症几率比高出 9 倍和 18 倍有关。其他研究参数与高胰岛素血症无明显关系,也不能预测高胰岛素血症的存在或患者随后的心血管风险。结论除 HOMA-IR 外,成人常用的心血管风险指数在确认儿童高胰岛素血症方面并不准确。需要进一步研究来验证特定心血管风险指数在高胰岛素血症儿童和青少年中的实用性。
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引用次数: 0
The Impact of Climate Change on Immunity and Gut Microbiota in the Development of Disease 气候变化对疾病发生过程中免疫力和肠道微生物群的影响
Pub Date : 2024-06-03 DOI: 10.3390/diseases12060118
P. Rio, Mario Caldarelli, Antonio Gasbarrini, G. Gambassi, Rossella Cianci
According to the definition provided by the United Nations, “climate change” describes the persistent alterations in temperatures and weather trends. These alterations may arise naturally, such as fluctuations in the solar cycle. Nonetheless, since the 19th century, human activities have emerged as the primary agent for climate change, primarily attributed to the combustion of fossil fuels such as coal, oil, and gas. Climate change can potentially influence the well-being, agricultural production, housing, safety, and employment opportunities for all individuals. The immune system is an important interface through which global climate change affects human health. Extreme heat, weather events and environmental pollutants could impair both innate and adaptive immune responses, promoting inflammation and genomic instability, and increasing the risk of autoimmune and chronic inflammatory diseases. Moreover, climate change has an impact on both soil and gut microbiome composition, which can further explain changes in human health outcomes. This narrative review aims to explore the influence of climate change on human health and disease, focusing specifically on its effects on the immune system and gut microbiota. Understanding how these factors contribute to the development of physical and mental illness may allow for the design of strategies aimed at reducing the negative impact of climate and pollution on human health.
根据联合国提供的定义,"气候变化 "是指气温和天气趋势的持续变化。这些变化可能是自然产生的,如太阳周期的波动。然而,自 19 世纪以来,人类活动已成为气候变化的主要因素,这主要归因于煤、石油和天然气等化石燃料的燃烧。气候变化有可能影响所有人的福祉、农业生产、住房、安全和就业机会。免疫系统是全球气候变化影响人类健康的一个重要界面。极端高温、天气事件和环境污染物会损害先天性免疫反应和适应性免疫反应,促进炎症和基因组的不稳定性,增加患自身免疫性疾病和慢性炎症性疾病的风险。此外,气候变化对土壤和肠道微生物组的组成也有影响,这可以进一步解释人类健康结果的变化。本综述旨在探讨气候变化对人类健康和疾病的影响,特别关注气候变化对免疫系统和肠道微生物群的影响。了解这些因素如何导致身体和精神疾病的发生,有助于制定旨在减少气候和污染对人类健康负面影响的战略。
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引用次数: 0
Surgical Resection and Immediate Reconstruction with a Bilayer Wound Collagen Matrix of a Rare Oral Angiosarcoma: A Case Report 罕见口腔血管肉瘤的手术切除和双层伤口胶原基质的即时重建:病例报告
Pub Date : 2024-06-03 DOI: 10.3390/diseases12060117
Enzo Iacomino, Chiara Fratini, Laura Sollima, Alberto Eibenstein, Christian Barbato, M. de Vincentiis, Antonio Minni, Federica Zoccali
Angiosarcomas are malignant vascular tumors that commonly occur on the skin of the head and neck, breast, or scalp. Oral angiosarcoma is a rare tumor (0.0077% of all cancers in Europe), and regarding this atypical localization, no formal treatment trials have been conducted yet. We present a case of a 58-year-old female patient with a diagnosis of oral angiosarcoma. After tumor excision was performed by transoral surgical approach, immediate reconstruction of the intraoral surgical defects was made using Integra® bilayer wound collagen matrix. A skin regeneration technique has previously been reported to provide good healing for defects of buccal resection, preventing postoperative cicatricial fibrosis.
血管肉瘤是一种恶性血管肿瘤,通常发生在头颈部、乳房或头皮的皮肤上。口腔血管肉瘤是一种罕见的肿瘤(占欧洲所有癌症的 0.0077%),对于这种不典型的定位,尚未进行过正式的治疗试验。我们报告了一例被诊断为口腔血管肉瘤的 58 岁女性患者的病例。经口手术切除肿瘤后,立即使用 Integra® 双层伤口胶原基质重建口腔内手术缺损。以前曾有报道称,皮肤再生技术可使口腔切除术后的缺损愈合良好,防止术后卡他性纤维化。
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引用次数: 0
The COVID-19 Experience in Adolescents: Emotional and Behavioral Recall at the End of the Pandemic 青少年的 COVID-19 体验:大流行结束时的情绪和行为回忆
Pub Date : 2024-06-02 DOI: 10.3390/diseases12060116
L. Zaccagni, Federica De Luca, N. Rinaldo, G. Mazzoni, S. Mandini, E. Gualdi-Russo
The COVID-19 pandemic and the resulting lockdown countermeasure may have significantly affected adolescents’ physical and mental health. This study aims to assess adolescents’ recollections of this period, also analyzing their current weight status along with factors they traced back to the epidemic phase and their current sports practice. A survey among 233 Italian adolescents aged 12.4 ± 0.9 years was conducted in October 2023. To achieve the research objectives, a new questionnaire was developed: the COVID-19 AdolesceNt/chilDren Lockdown Experience questionnaire (CANDLE). The new questionnaire was employed to gather data on the adolescents’ recollections of the lockdown situation they experienced. The stature and weight of participants were measured directly. The results indicated that middle schoolers remember both positive and negative experiences of the lockdown: the change perceived as the most positive was spending more time with family, while social detachment from peers represents the most negative aspect. According to multivariate regression analysis, certain behaviors they assumed during the lockdown, such as comfort food consumption in boys and sleeping disturbances in girls, in addition to their current sports practice, affected their actual Body Mass Index. This study supports the evidence that changes caused by the COVID-19 lockdown affected adolescents’ physical and mental health, albeit with sex differences.
COVID-19 大流行以及随之而来的封锁对策可能对青少年的身心健康产生了重大影响。本研究旨在评估青少年对这段时期的回忆,同时分析他们目前的体重状况,以及他们追溯到流行病阶段的因素和他们目前的体育锻炼情况。本研究于 2023 年 10 月对 233 名年龄为 12.4 ± 0.9 岁的意大利青少年进行了调查。为实现研究目标,我们开发了一份新的问卷:COVID-19 青少年/儿童禁闭体验问卷(CANDLE)。新问卷用于收集青少年对他们所经历的封锁情况的回忆数据。对参与者的身材和体重进行了直接测量。结果表明,初中生对封锁的记忆既有积极的一面,也有消极的一面:他们认为最积极的变化是有更多的时间与家人在一起,而与同龄人疏远则是最消极的一面。根据多元回归分析,除了当前的体育锻炼外,他们在封锁期间的某些行为,如男生吃安慰性食物和女生睡眠紊乱,也影响了他们的实际体重指数。这项研究证实,COVID-19 封锁造成的变化影响了青少年的身心健康,尽管存在性别差异。
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引用次数: 0
Fetus Exposure to Drugs and Chemicals: A Holistic Overview on the Assessment of Their Transport and Metabolism across the Human Placental Barrier 胎儿接触药物和化学品:评估药物和化学品通过人体胎盘屏障的迁移和代谢的综合概述
Pub Date : 2024-06-01 DOI: 10.3390/diseases12060114
I. Kotta-Loizou, Agathi A Pritsa, Georgios Antasouras, Spyridon N Vasilopoulos, Gavriela Voulgaridou, S. Papadopoulou, Robert H. A. Coutts, Eleftherios Lechouritis, C. Giaginis
Background: The placenta exerts a crucial role in fetus growth and development during gestation, protecting the fetus from maternal drugs and chemical exposure. However, diverse drugs and chemicals (xenobiotics) can penetrate the maternal placental barrier, leading to deleterious, adverse effects concerning fetus health. Moreover, placental enzymes can metabolize drugs and chemicals into more toxic compounds for the fetus. Thus, evaluating the molecular mechanisms through which drugs and chemicals transfer and undergo metabolism across the placental barrier is of vital importance. In this aspect, this comprehensive literature review aims to provide a holistic approach by critically summarizing and scrutinizing the potential molecular processes and mechanisms governing drugs and chemical transfer and metabolism across the placental barrier, which may lead to fetotoxicity effects, as well as analyzing the currently available experimental methodologies used to assess xenobiotics placental transfer and metabolism. Methods: A comprehensive and in-depth literature review was conducted in the most accurate scientific databases such as PubMed, Scopus, and Web of Science by using relevant and effective keywords related to xenobiotic placental transfer and metabolism, retrieving 8830 published articles until 5 February 2024. After applying several strict exclusion and inclusion criteria, a final number of 148 relevant published articles were included. Results: During pregnancy, several drugs and chemicals can be transferred from the mother to the fetus across the placental barrier by either passive diffusion or through placental transporters, resulting in fetus exposure and potential fetotoxicity effects. Some drugs and chemicals also appear to be metabolized across the placental barrier, leading to more toxic products for both the mother and the fetus. At present, there is increasing research development of diverse experimental methodologies to determine the potential molecular processes and mechanisms of drug and chemical placental transfer and metabolism. All the currently available methodologies have specific strengths and limitations, highlighting the strong demand to utilize an efficient combination of them to obtain reliable evidence concerning drug and chemical transfer and metabolism across the placental barrier. To derive the most consistent and safe evidence, in vitro studies, ex vivo perfusion methods, and in vivo animal and human studies can be applied together with the final aim to minimize potential fetotoxicity effects. Conclusions: Research is being increasingly carried out to obtain an accurate and safe evaluation of drug and chemical transport and metabolism across the placental barrier, applying a combination of advanced techniques to avoid potential fetotoxic effects. The improvement of the currently available techniques and the development of novel experimental protocols and methodologies are of major importance to protect both the mo
背景:胎盘在妊娠期间对胎儿的生长发育起着至关重要的作用,保护胎儿免受母体药物和化学物质的影响。然而,各种药物和化学物质(异生物)可穿透母体胎盘屏障,对胎儿健康产生有害的不良影响。此外,胎盘酶可将药物和化学物质代谢成对胎儿毒性更大的化合物。因此,评估药物和化学物质通过胎盘屏障转移和代谢的分子机制至关重要。在这方面,本综合文献综述旨在提供一种整体方法,通过批判性地总结和仔细研究药物和化学物质通过胎盘屏障转移和代谢的潜在分子过程和机制(这可能会导致胎儿毒性效应),以及分析目前用于评估异种生物胎盘转移和代谢的可用实验方法。研究方法通过使用与异生物胎盘转移和代谢相关的有效关键词,在 PubMed、Scopus 和 Web of Science 等最准确的科学数据库中进行了全面深入的文献综述,检索到截至 2024 年 2 月 5 日已发表的 8830 篇文章。在采用了若干严格的排除和纳入标准后,最终纳入了 148 篇相关的已发表文章。研究结果在妊娠期间,一些药物和化学物质可通过被动扩散或胎盘转运体从母体转移到胎儿的胎盘屏障,从而导致胎儿接触这些药物和化学物质并产生潜在的胎毒效应。有些药物和化学物质似乎还会通过胎盘屏障进行新陈代谢,从而产生对母体和胎儿毒性更强的产物。目前,为确定药物和化学物质胎盘转移和代谢的潜在分子过程和机制,各种实验方法的研究开发日益增多。目前所有可用的方法都有其特定的优势和局限性,这就强烈要求将这些方法有效地结合起来,以获得有关药物和化学物质通过胎盘屏障转移和代谢的可靠证据。为了获得最一致、最安全的证据,体外研究、体外灌注方法以及体内动物和人体研究可以结合使用,最终目的是将潜在的胎儿毒性影响降至最低。结论为准确、安全地评估药物和化学物质通过胎盘屏障的转运和代谢情况,目前正在开展越来越多的研究,并将多种先进技术结合使用,以避免潜在的胎儿毒性影响。改进现有技术、开发新的实验方案和方法对保护母亲和胎儿免受异生物暴露以及最大限度地减少潜在的胎儿毒性影响至关重要。
{"title":"Fetus Exposure to Drugs and Chemicals: A Holistic Overview on the Assessment of Their Transport and Metabolism across the Human Placental Barrier","authors":"I. Kotta-Loizou, Agathi A Pritsa, Georgios Antasouras, Spyridon N Vasilopoulos, Gavriela Voulgaridou, S. Papadopoulou, Robert H. A. Coutts, Eleftherios Lechouritis, C. Giaginis","doi":"10.3390/diseases12060114","DOIUrl":"https://doi.org/10.3390/diseases12060114","url":null,"abstract":"Background: The placenta exerts a crucial role in fetus growth and development during gestation, protecting the fetus from maternal drugs and chemical exposure. However, diverse drugs and chemicals (xenobiotics) can penetrate the maternal placental barrier, leading to deleterious, adverse effects concerning fetus health. Moreover, placental enzymes can metabolize drugs and chemicals into more toxic compounds for the fetus. Thus, evaluating the molecular mechanisms through which drugs and chemicals transfer and undergo metabolism across the placental barrier is of vital importance. In this aspect, this comprehensive literature review aims to provide a holistic approach by critically summarizing and scrutinizing the potential molecular processes and mechanisms governing drugs and chemical transfer and metabolism across the placental barrier, which may lead to fetotoxicity effects, as well as analyzing the currently available experimental methodologies used to assess xenobiotics placental transfer and metabolism. Methods: A comprehensive and in-depth literature review was conducted in the most accurate scientific databases such as PubMed, Scopus, and Web of Science by using relevant and effective keywords related to xenobiotic placental transfer and metabolism, retrieving 8830 published articles until 5 February 2024. After applying several strict exclusion and inclusion criteria, a final number of 148 relevant published articles were included. Results: During pregnancy, several drugs and chemicals can be transferred from the mother to the fetus across the placental barrier by either passive diffusion or through placental transporters, resulting in fetus exposure and potential fetotoxicity effects. Some drugs and chemicals also appear to be metabolized across the placental barrier, leading to more toxic products for both the mother and the fetus. At present, there is increasing research development of diverse experimental methodologies to determine the potential molecular processes and mechanisms of drug and chemical placental transfer and metabolism. All the currently available methodologies have specific strengths and limitations, highlighting the strong demand to utilize an efficient combination of them to obtain reliable evidence concerning drug and chemical transfer and metabolism across the placental barrier. To derive the most consistent and safe evidence, in vitro studies, ex vivo perfusion methods, and in vivo animal and human studies can be applied together with the final aim to minimize potential fetotoxicity effects. Conclusions: Research is being increasingly carried out to obtain an accurate and safe evaluation of drug and chemical transport and metabolism across the placental barrier, applying a combination of advanced techniques to avoid potential fetotoxic effects. The improvement of the currently available techniques and the development of novel experimental protocols and methodologies are of major importance to protect both the mo","PeriodicalId":11200,"journal":{"name":"Diseases","volume":"32 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141277690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Integrating Machine Learning in Clinical Practice for Characterizing the Malignancy of Solitary Pulmonary Nodules in PET/CT Screening 将机器学习融入临床实践,在 PET/CT 筛查中确定单发肺结节的恶性程度
Pub Date : 2024-06-01 DOI: 10.3390/diseases12060115
Ioannis D. Apostolopoulos, Nikolaos D. Papathanasiou, D. Apostolopoulos, Nikolaos I. Papandrianos, Elpiniki I. Papageorgiou
The study investigates the efficiency of integrating Machine Learning (ML) in clinical practice for diagnosing solitary pulmonary nodules’ (SPN) malignancy. Patient data had been recorded in the Department of Nuclear Medicine, University Hospital of Patras, in Greece. A dataset comprising 456 SPN characteristics extracted from CT scans, the SUVmax score from the PET examination, and the ultimate outcome (benign/malignant), determined by patient follow-up or biopsy, was used to build the ML classifier. Two medical experts provided their malignancy likelihood scores, taking into account the patient’s clinical condition and without prior knowledge of the true label of the SPN. Incorporating human assessments into ML model training improved diagnostic efficiency by approximately 3%, highlighting the synergistic role of human judgment alongside ML. Under the latter setup, the ML model had an accuracy score of 95.39% (CI 95%: 95.29–95.49%). While ML exhibited swings in probability scores, human readers excelled in discerning ambiguous cases. ML outperformed the best human reader in challenging instances, particularly in SPNs with ambiguous probability grades, showcasing its utility in diagnostic grey zones. The best human reader reached an accuracy of 80% in the grey zone, whilst ML exhibited 89%. The findings underline the collaborative potential of ML and human expertise in enhancing SPN characterization accuracy and confidence, especially in cases where diagnostic certainty is elusive. This study contributes to understanding how integrating ML and human judgement can optimize SPN diagnostic outcomes, ultimately advancing clinical decision-making in PET/CT screenings.
本研究探讨了在临床实践中整合机器学习(ML)诊断单发肺结节(SPN)恶性肿瘤的效率。希腊帕特雷大学医院核医学科记录了患者数据。数据集包括从 CT 扫描中提取的 456 个 SPN 特征、PET 检查的 SUVmax 分数以及通过患者随访或活检确定的最终结果(良性/恶性),用于构建 ML 分类器。两位医学专家考虑到患者的临床状况,在事先不了解 SPN 真实标签的情况下提供了恶性可能性评分。将人工评估纳入 ML 模型训练可将诊断效率提高约 3%,这凸显了人工判断与 ML 的协同作用。在后一种设置下,ML 模型的准确率为 95.39%(CI 95%:95.29-95.49%)。虽然 ML 在概率得分上表现出波动性,但人类读者在辨别模棱两可的案例方面表现出色。在具有挑战性的情况下,尤其是在概率等级不明确的 SPN 中,ML 的表现优于最佳人类阅读器,显示了其在诊断灰色地带的实用性。最佳人类阅读器在灰色区域的准确率为 80%,而 ML 的准确率为 89%。研究结果凸显了人工智能和人类专业知识在提高 SPN 特征描述准确性和可信度方面的合作潜力,尤其是在诊断确定性难以确定的情况下。这项研究有助于了解如何将人工智能和人类判断结合起来,优化 SPN 诊断结果,最终推动 PET/CT 筛查的临床决策。
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引用次数: 0
Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic 南非中心医院 COVID-19 疫苗接种点在经历四次大流行后提供疫苗的可行性和疫苗接种意愿
Pub Date : 2024-05-24 DOI: 10.3390/diseases12060113
Shanal Nair, K. Tshabalala, N. Slingers, L. Vanleeuw, Debashis Basu, Fareed Abdullah
Background: As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Aim: Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. Objectives: To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Methods: Mixed-methods study using quantitative and qualitative methods. Results: Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. Conclusions: This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient–clinician engagement about the benefits of vaccination is
背景:由于第四波和第五波的死亡率与前几波相比明显下降,南非的专家和公众都提出了 COVID-19 疫苗接种的未来作用问题。一般公众现在被认为罹患 COVID-19 严重疾病的风险很低,因此,人们普遍认为,疫苗接种活动应该只关注那些极易罹患 COVID-19 严重疾病和死亡的人群。这部分人主要是在医院门诊部就诊的常见慢性病患者。我们假设,在中心医院现场提供 COVID-19 疫苗接种将提高合并慢性疾病患者的接种率,这些患者在大流行的 Omicron 阶段最需要接种。目的: 评估在医院门诊部为患者提供疫苗接种点的可接受性、需求和接种率。目标:评估中心医院就诊者的疫苗接种率、覆盖率和犹豫性,确定与疫苗接种率相关和影响疫苗接种率的因素,记录疫苗接种项目的实施情况并评估医院员工和就诊者对疫苗接种项目的接受程度。研究方法:采用定量和定性方法进行混合研究。研究结果在参与研究的 317 名参与者中,有 229 人(72%)已接种过至少一剂 COVID-19 疫苗。根据南非卫生部的指导方针,共有 296 名参与者符合首次接种、额外接种或加强接种的条件。在之前接种过疫苗的人中,有 65% 的人选择在提供疫苗的当天(当天)再接种一剂。只有 13 名以前未接种过疫苗的参与者(占疫苗接种幼稚参与者的 15%)选择了接种,使至少接种一剂疫苗的覆盖率从 72% 提高到 76%。所有参与者中约有 24%(n = 75)的人拒绝接种疫苗(疫苗犹豫者)。疫苗接种情况的相关变量测试表明,年龄达到了统计学意义。定性分析中新出现的主题包括对脆弱性的看法、对疫苗安全性和有效性的担忧、有关疫苗接种的信息缺口、方便性在疫苗接种决定中的价值以及健康促进者的作用。结论:这项研究表明,在大型医院为慢性病门诊患者提供疫苗接种点在后勤上是可以接受的。这项服务也有利于陪同人员和医院工作人员。疫苗接种点的可及性和便利性会影响决策,从而增加接种疫苗的机会。然而,疫苗接种犹豫不决的现象非常普遍,在所有获得疫苗接种的人中,仅有不到四分之一的人仍未接种疫苗。加强有关疫苗接种益处的健康教育和患者与医生的沟通,对于向经常到医院门诊部就诊的高危人群提供适当的疫苗接种计划至关重要。
{"title":"Feasibility of Provision and Vaccine Hesitancy at a Central Hospital COVID-19 Vaccination Site in South Africa after Four Waves of the Pandemic","authors":"Shanal Nair, K. Tshabalala, N. Slingers, L. Vanleeuw, Debashis Basu, Fareed Abdullah","doi":"10.3390/diseases12060113","DOIUrl":"https://doi.org/10.3390/diseases12060113","url":null,"abstract":"Background: As mortality declined significantly during the fourth and fifth waves compared to previous waves, the question of the future role of COVID-19 vaccination arose among both experts and the public in South Africa. Turning attention away from the general public, now considered to be at very low risk of severe COVID-19 disease, a commonly held view was that the vaccination campaign should focus only on those who remain highly vulnerable to severe disease and death from COVID-19. Primary amongst this group are patients with common chronic diseases attending hospital outpatient departments. We hypothesized that providing COVID-19 vaccinations on-site at a central hospital will increase uptake for the patients with co-morbid chronic conditions who need them most in the Omicron phase of the pandemic. Aim: Evaluate the acceptability, need, and uptake of a hospital-based vaccination site for patients attending the medical hospital outpatient departments. Objectives: To assess vaccination uptake, coverage, and hesitancy in people attending a central hospital, to determine factors associated with and influencing vaccination uptake, and to document implementation and assess acceptability of the vaccination project among staff and persons attending the hospital. Methods: Mixed-methods study using quantitative and qualitative methods. Results: Of the 317 participants enrolled in the study, 229 (72%) had already received at least one dose of the COVID-19 vaccine. A total of 296 participants were eligible for a first vaccination, additional vaccination, or booster vaccination according to the South African Department of Health guidelines. Of those previously vaccinated, 65% opted for an additional dose on the day it was offered (same day). Only 13 previously unvaccinated participants (15% of vaccine naïve participants) opted for vaccination, increasing vaccine coverage with at least one dose from 72% to 76%. Approximately 24% (n = 75) of all participants refused vaccination (vaccine hesitant). Variables tested for an association with vaccination status demonstrated that age reached statistical significance. Emerging themes in the qualitative analysis included perceptions of vulnerability, vaccine safety and efficacy concerns, information gaps regarding vaccinations, the value of convenience in the decision to vaccinate, and the role of health promoters. Conclusions: This study has shown that it is logistically acceptable to provide a vaccination site at a large hospital targeting patients attending outpatient services for chronic medical conditions. This service also benefits accompanying persons and hospital staff. Access and convenience of the vaccination site influence decision-making, increasing the opportunity to vaccinate. However, vaccine hesitancy is widespread with just under one-quarter of all those offered vaccinations remaining unvaccinated. Strengthening health education and patient–clinician engagement about the benefits of vaccination is","PeriodicalId":11200,"journal":{"name":"Diseases","volume":"74 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141101767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Wernicke Encephalopathy Caused by Avoidance-Restrictive Food Intake Disorder in a Child: A Case-Based Review 儿童回避-限制性食物摄入障碍引发的韦尼克脑病:基于病例的回顾
Pub Date : 2024-05-24 DOI: 10.3390/diseases12060112
Ida Turrini, Clotilde Guidetti, I. Contaldo, S. Pulitanò, D. Rigante, Chiara Veredice
Background: Wernicke encephalopathy (WE) is an acute and potentially fatal neuropsychiatric disorder resulting from thiamine deficiency: its etiology and clinical presentation can be heterogeneous and arduously recognized, especially in children and adolescents. Case presentation: An 8-year-old girl arrived to the emergency room with ataxic gait, nystagmus, and mental confusion after a 10-day history of repeated severe vomiting; her recent clinical history was characterized by restricted nutrition due to a choking phobia, which caused substantial weight loss. Brain magnetic resonance imaging revealed a bilaterally increased T2 signal in the medial areas of the thalami and cerebral periaqueductal region. Diagnosis of WE based on clinical and neuroradiological findings was established and confirmed after labwork showing low serum thiamine. Following psychiatric evaluation, the patient was also diagnosed with avoidance-restrictive food intake disorder (ARFID), which required starting cognitive behavioral therapy and introducing aripiprazole. The patient displayed improvement of the radiological findings after one month and complete resolution of her neurological symptoms and signs. Conclusions: Eating disorders like ARFID might forerun acute signs of WE; this possibility should be considered even in pediatric patients, especially when atypical neurological pictures or feeding issues come out.
背景:韦尼克脑病(Wernicke encephalopathy,WE)是一种由硫胺素缺乏引起的急性、潜在致命的神经精神疾病:其病因和临床表现多种多样,难以识别,尤其是在儿童和青少年中。病例介绍:一名 8 岁女孩因反复剧烈呕吐 10 天后出现共济失调步态、眼球震颤和精神错乱而被送入急诊室;其近期临床病史的特点是因窒息恐惧症而限制营养,导致体重大幅下降。脑磁共振成像显示,丘脑内侧区域和大脑下隐窝区域的T2信号双侧增高。根据临床和神经放射学检查结果,确定了WE的诊断,并在实验室检查显示血清硫胺素偏低后予以确诊。经过精神评估,患者还被诊断为回避-限制性食物摄入障碍(ARFID),需要开始认知行为疗法并使用阿立哌唑。一个月后,患者的放射学检查结果有所改善,神经系统症状和体征也完全消失。结论ARFID等进食障碍可能会先于WE的急性症状出现;即使是儿童患者也应考虑到这种可能性,尤其是当出现不典型的神经症状或进食问题时。
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引用次数: 0
Prognostic Factors Associated with Breast Cancer-Specific Survival from 1995 to 2022: A Systematic Review and Meta-Analysis of 1,386,663 Cases from 30 Countries 1995 年至 2022 年与乳腺癌生存率相关的预后因素:对 30 个国家 1,386,663 例病例的系统回顾和元分析
Pub Date : 2024-05-23 DOI: 10.3390/diseases12060111
Hanif Abdul Rahman, Siti Nurzaimah Nazhirah Zaim, Ummi Salwa Suhaimei, Al Amin Jamain
Breast cancer is the fifth-ranked cancer globally. Despite early diagnosis and advances in treatment, breast cancer mortality is increasing. This meta-analysis aims to examine all possible prognostic factors that improve/deteriorate breast cancer-specific survival. MEDLINE, PubMed, ScienceDirect, Ovid, and Google Scholar were systematically searched until September 16, 2023. The retrieved studies from 1995 to 2022 accumulated 1,386,663 cases from 30 countries. A total of 13 out of 22 prognostic factors were significantly associated with breast cancer-specific survival. A random-effects model provided a pooled estimate of the top five poorest prognostic factors, including Stage 4 (HR = 12.12; 95% CI: 5.70, 25.76), followed by Stage 3 (HR = 3.42, 95% CI: 2.51, 4.67), a comorbidity index ≥ 3 (HR = 3.29; 95% CI: 4.52, 7.35), the poor differentiation of cancer cell histology (HR = 2.43; 95% CI: 1.79, 3.30), and undifferentiated cancer cell histology (HR = 2.24; 95% CI: 1.66, 3.01). Other survival-reducing factors include positive nodes, age, race, HER2-receptor positivity, and overweight/obesity. The top five best prognostic factors include different types of mastectomies and breast-conserving therapies (HR = 0.56; 95% CI: 0.44, 0.70), medullary histology (HR = 0.62; 95% CI: 0.53, 0.72), higher education (HR = 0.72; 95% CI: 0.68, 0.77), and a positive estrogen receptor status (HR = 0.78; 95% CI: 0.65, 0.94). Heterogeneity was observed in most studies. Data from developing countries are still scarce.
乳腺癌是全球排名第五的癌症。尽管早期诊断和治疗手段不断进步,但乳腺癌的死亡率仍在上升。本荟萃分析旨在研究提高/降低乳腺癌特异性生存率的所有可能的预后因素。截至 2023 年 9 月 16 日,我们对 MEDLINE、PubMed、ScienceDirect、Ovid 和 Google Scholar 进行了系统检索。从 1995 年到 2022 年,共检索到来自 30 个国家的 1,386,663 个病例。在22个预后因素中,共有13个与乳腺癌特异性生存率有显著相关。随机效应模型对最差的五个预后因素进行了汇总估计,其中包括第 4 期(HR = 12.12;95% CI:5.70, 25.76),其次是第 3 期(HR = 3.42,95% CI:2.51, 4.67)、合并症指数(HR = 2.51,95% CI:2.51, 4.67)、乳腺癌特异性生存率(HR = 3.42,95% CI:2.51, 4.67)。67)、合并症指数≥3(HR = 3.29;95% CI:4.52,7.35)、癌细胞组织学分化差(HR = 2.43;95% CI:1.79,3.30)和癌细胞组织学未分化(HR = 2.24;95% CI:1.66,3.01)。其他降低生存率的因素包括结节阳性、年龄、种族、HER2受体阳性和超重/肥胖。前五位最佳预后因素包括不同类型的乳房切除术和保乳疗法(HR = 0.56;95% CI:0.44,0.70)、髓质组织学(HR = 0.62;95% CI:0.53,0.72)、高等教育(HR = 0.72;95% CI:0.68,0.77)和雌激素受体阳性状态(HR = 0.78;95% CI:0.65,0.94)。大多数研究都存在异质性。发展中国家的数据仍然很少。
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引用次数: 0
Comparing Relationship Satisfaction and Body-Image-Related Quality of Life in Pregnant Women with Planned and Unplanned Pregnancies 比较计划怀孕和非计划怀孕孕妇的人际关系满意度和与身体形象相关的生活质量
Pub Date : 2024-05-22 DOI: 10.3390/diseases12060109
Razvan Daniluc, Marius Craina, Barkha Rani Thakur, Mihaela Prodan, Melania Lavinia Bratu, Ana-Maria Cristina Daescu, G. Puenea, Bogdan Niculescu, R. Negrean
This comparative cross-sectional study conducted at the “Pius Brinzeu” healthcare center in Timisoara explored the differential impacts of pregnancy planning status on sexual function, body image, and relationship satisfaction among pregnant women. Employing the Female Sexual Function Index (FSFI), Body Esteem Scale for Adolescents and Adults (BESAQ), and the Beck Depression Inventory (BDI-II), the study analyzed responses from 107 participants divided into groups of planned (n = 59, mean age 28.5 ± 5.2) and unplanned (n = 48, mean age 27.3 ± 4.8) pregnancies. In the first trimester, unplanned pregnancies reported higher median scores in desire (4.7 vs. 3.6, p = 0.005), arousal (4.5 vs. 3.8, p = 0.001), and lubrication (4.6 vs. 3.7, p = 0.015) compared to planned pregnancies. Satisfaction scores also favored unplanned pregnancies in the first trimester (4.8 vs. 3.9, p = 0.009). Similar trends were observed in subsequent trimesters, with unplanned pregnancies consistently reporting higher FSFI scores, indicating a robust sexual function. Risk factors significantly associated with sexual dysfunction were a higher BMI in the first trimester (beta coefficient: −0.124, p = 0.019), unmarried civil status (beta coefficient: −0.323, p = 0.045), history of previous abortion (beta coefficient: −0.451, p = 0.012), irregular menstrual cycles (beta coefficient: −0.384, p = 0.026), and rural living area (beta coefficient: −0.278, p = 0.034). Notably, unplanned pregnancy itself was not a significant risk factor for sexual dysfunction (beta coefficient: −0.054, p = 0.095). Regarding relationship dynamics, planned pregnancies exhibited significantly higher satisfaction with partner support (4.1 ± 0.9 vs. 3.7 ± 1.1, p = 0.041) and communication within the couple (4.0 ± 1.0 vs. 3.5 ± 1.2, p = 0.020), whereas unplanned pregnancies reported higher satisfaction with emotional closeness (4.3 ± 0.7 vs. 3.8 ± 1.0, p = 0.004). Concerns about managing professional activities and household chores were significantly more prevalent in the unplanned pregnancy group (62.50% vs. 33.90%, p = 0.014). Unplanned pregnancies demonstrated better initial sexual function but faced greater challenges in relationship satisfaction and managing pregnancy demands. Identifying and addressing the risk factors associated with sexual dysfunction can provide targeted interventions to improve the well-being of pregnant women, regardless of pregnancy planning status.
这项在蒂米什瓦拉 "皮乌斯-布林泽乌 "医疗中心进行的横断面比较研究探讨了计划怀孕状态对孕妇性功能、身体形象和关系满意度的不同影响。该研究采用女性性功能指数(FSFI)、青少年和成人身体自尊量表(BESAQ)和贝克抑郁量表(BDI-II),对 107 名参与者的回答进行了分析,这些参与者被分为计划内怀孕组(n = 59,平均年龄为 28.5 ± 5.2)和计划外怀孕组(n = 48,平均年龄为 27.3 ± 4.8)。在妊娠头三个月,与计划内妊娠相比,计划外妊娠在欲望(4.7 对 3.6,p = 0.005)、唤醒(4.5 对 3.8,p = 0.001)和润滑(4.6 对 3.7,p = 0.015)方面的中位数得分更高。满意度得分在前三个月也更倾向于计划外怀孕(4.8 vs. 3.9,p = 0.009)。在随后的三个月中也观察到了类似的趋势,计划外怀孕的孕妇始终报告较高的 FSFI 分数,表明其性功能旺盛。与性功能障碍明显相关的风险因素有:怀孕头三个月的体重指数较高(贝塔系数:-0.124,p = 0.019)、未婚婚姻状况(贝塔系数:-0.323,p = 0.045)、既往流产史(β 系数:-0.451,P = 0.012)、月经周期不规律(β 系数:-0.384,P = 0.026)和居住地为农村(β 系数:-0.278,P = 0.034)。值得注意的是,计划外怀孕本身并不是性功能障碍的重要风险因素(贝塔系数:-0.054,p = 0.095)。在夫妻关系动态方面,计划内怀孕者对伴侣支持(4.1 ± 0.9 vs. 3.7 ± 1.1,p = 0.041)和夫妻沟通(4.0 ± 1.0 vs. 3.5 ± 1.2,p = 0.020)的满意度明显更高,而计划外怀孕者对情感亲密程度的满意度更高(4.3 ± 0.7 vs. 3.8 ± 1.0,p = 0.004)。计划外怀孕组对职业活动和家务管理的关注度明显更高(62.50% 对 33.90%,p = 0.014)。非计划怀孕组的初始性功能较好,但在人际关系满意度和处理怀孕需求方面面临更大的挑战。识别并解决与性功能障碍相关的风险因素,可以提供有针对性的干预措施,以改善孕妇的福祉,无论其怀孕计划状况如何。
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引用次数: 0
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Diseases
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